Natural orifice transluminal endoscopic surgery in the treatment of patients with abdominal compartment syndrome during severe acute pancreatitis

Abstract

Objective To investigate value of embryonic natural orifice transluminal endoscopic surgery (ENOTES) in the treatment of patients with abdominal compartment syndrome (ACS) complicated by severe acute pancreatitis.Methods The patients with ACS complicated by SAP were,randomly divided into two groups,Group ENOTES and Group surgical operation.On the base of routine therapy the embryonic natural orifice transluminal endoscopic surgery with flexible endoscope was performed for 32 patients with ACS complicated by SAP during 4 hr of admission,whereas,surgical operation was carried out for 28patients with ACS complicated by SAP during 4 hr of admission.Intra-abdominal pressure,changes of APACHE Ⅱ scores,cure rate,and complications between Group ENOTES and Group surgical operation were compared.Results There was no significant difference between Group ENOTES and Group surgical operation in intra-abdominal pressure at admission with (22.57 ± 7.48) cmH2O vs.(24.000 ± 5.62)cmH 2O,(P ＞0.05).Intra-abdominal pressure in Group ENOTES was (12.09 ±5.23) cmH 2O,(9.41±3.12) cmH 2O,(7.87 ±2.24) cmH 2O and (7.15 ± 1.34) cmH 2O at 1st,3rd,5th and 7th day after ENOTES.Compared with Group ENOTES,intra-abdominal pressure in Group surgical operation was (12.55±2.88) cmH 2O,(8.82±4.14) cmH2O,(7.45 ±2.38) cmH 2O,and (7.54±3.18) cmH2O at 1st,3rd,5th and 7th day after surgical operation.There was no statistical differences in intraabdominal pressure after operations between two groups (p ＞ 0.05).At admission there was no significant differences between Group ENOTES and Group surgical operation in the scre of APACHE Ⅱ [(14.82 ± 4.00) vs (17.00 ± 6.78),P ＞ 0.05].The scores of APACHE Ⅱ in Group ENOTES were (10.05 ±2.43),(8.74 ± 2.48),(7.18 ± 2.72) and (6.35 ± 2.78) at 1 st,3rd,5th and 7th day after ENOTES.Compared whth Group ENOTES,the scores of APACHE in Group surgical operation were (13.38 ±3.12),(12.92±4.03),(10.08 ±3.30) and (9.54 ±3.18) at 1st,3rd,5th and 7th day after surgical operation.There was significant differences between two groups in the scores of APACHE after operations (P ＜0.05).The cure rate was 96.8％ in ENOTES group and 78.5％ in surgical operation group.The difference between ENOTES group and surgical operation group in cure rate had significant (P ＜ 0.05).The complications accounted for 12.5％ in ENOTES group and 50.0％ in surgical operation group.There was significantly different between ENOTES group and surgical operation group in the complications.(P ＜0.01).Conclusions Emergency ENOTES with flexible endoscope is a safe,effective,minimal invasive and fewer complication method for patients with ACS associated with severe acute pancreatitis. Key words: Embryonic natural orifice transluminal endoscopic surgery; Abdominal cavity lavage; Peritoneal dialysis; Severe acute pancreatitis; Abdominal compartment syndrome; Inflammatory mediator; Systemic inflammatory response syndrome; Multiple organ dysfunction syndrome; Capillary leak